All Things Pancreas Flashcards
(32 cards)
3 MCCs of Acute Pancreatitis with percentages (excluding idiopathic causes).
Gallstones are responsible for 40%. EtOH is 30%. Hypertriglyceridemia is 3%. Idiopathic accounts for 20% of pts.
What is the pathogenesis of acute pancreatitis?
Pressure or activation of the pancreatic zymogens that normally cleave and break down protein, fat in the intestine are now doing self autolysis - leading to damage and inflammation.
How does a pt with pancreatitis present and how do we diagnose it?
Pt presents with the universal symptoms of epigastric pain with nausea and vomiting that is worse after eating. Sometimes pt will say it radiates to the back (retroperitoneal) or increased tenderness on palpation.
SAD PUCKER is a mnemonic for what?
Retroperitoneal organs. Suprarenal glands, aorta/ivc, 2nd and 3rd parts of duodenum. Pancreas (except the tail), ureters, colon (ascending and descending), Kidneys, Esophagus, Rectum.
If pancreatitis is suspected, how do I diagnose?
Requires 2/3 of the following: 1. Epigastric pain is a no brainer. 2. Elevated amylase or lipase by 3x normal. 3. CT or MRI with contrast imaging.
Treatment of Acute Pancreatitis.
If gallstone related - remove it. Otherwise, Supportive with careful observation of electrolytes and concern for distributive shock in first week. Do not allow pt to eat until they are improved.
I GET SMASHED is a mnemonic for…
Causes of Acute Pancreatitis. Idiopathic. Gallstones, EtOH, Triglycerides/Trauma share the T.
Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia, ERCP (which should never have to be spelled out), Drugs (Sulfa and HIV meds).
What does ERCP stand for and what complications could it cause besides acute pancreatitis?
endoscopic retrograde cholangiopancreatography. Can cause bowel perforation and or bleeding. Gastroenterologist puts flexible tube until it reaches the sphincter of oddi to look at the biliary and pancreatic system.
Where is the Ampulla of Vater?
It is where the CBD enters the intestine releasing bile and pancreatic enzymes. It is surrounded by the musculature of SoD.
Where would the obstruction of the gallstone need to be to lead to acute pancreatitis?
Ampulla of Vater/Sphincter of Oddi.
Aggressive fluid resuscitation in Acute Pancreatitis is due to the concern for what 3 complications?
Fluid loss occurs from Pancreatic capillary edema. Or Leakage into peritoneum aka Peripancreatic fluid collection. Or most famously and more late of a complication - Pseudocyst.
Why is a pancreatic Pseudocyst called a Pseudocyst?
It does not have any epithelium on the inside - merely granulation tissue.
What kind of vascular damage can acute pancreatitis cause?
Neighboring Splenic vasculature can be disrupted and lead to hemorrhage from erosion and varied patches of necrosis with secondary infection bc difficult to remove the necrosis.. May require debridement.
What other Cxs may occur in Acute Pancreatitis?
Hemorrhage from splenic vasculature. Patchy necrosis that is hard to filter out thereby leading to infection. It can move on to be Chronic Pancreatitis if acute never resolves.
- Hemorrhage. 2. Necrosis 3. Infection (in 1/3rd of necrotic cases) 4. Chronic pancreatitis.
What metabolites are affected systemically from pancreatic inflammation which is dangerous for the pt in the first week and requires constant supervision?
Calcium and Glucose. Calcium can drop abruptly and Glucose may rise abruptly.
What is SIRS? What are the 4 Dx criteria?
Systemic Inflammatory Response Syndrome.
Tachycardia, Tachypnea (respiratory rate >20 breaths/min), fever or hypothermia, and leukocytosis, leukopenia, or bandemia. Eventually leads to Shock.
Inflammatory cascade leading to distributive shock from Acute Pancreatitis targets which 2 organs most?
Lungs (ARDS) and Kidneys ( AKI from fluid loss from distributive shock rerouted to brain and heart)
Why keep pt from eating during acute pancreatitis?
We do not want to stimulate the pancreas to secrete anything else.
What occurs in chronic pancreatitis? 2 MCCs?
Pancreas tired of abuse fibroses and shrivels up.
Ethanol and Cystic Fibrosis gunking up the ducts.
What are the 2 classic radiographic features of Chronic Pancreatitis?
Atrophy of the pancreas and granular calcifications.
What are the severe Sxs of Pancreatic Insufficiency from Chronic Pancreatitis?
Destruction of beta cells - leading to a insulin-dependent diabetes prone to hypoglycemia from overtreatment (not as bad as Type 1), chronic stomach pain, recurrent pseudocysts. Loss of Somatostatin and Glucagon aren’t as obvious. Delta cells are still found in the antrum of the stomach.
Loss of fat digestion is especially prominent causing steatorrhea + consequential fat soluble vitamin deficiencies.
Why can we not use Amylase and Lipase to diagnose Chronic Pancreatitis?
Like in cirrhosis, if the pancreas is too insufficient it will not be releasing the two in high quantities. High levels of Amylase and Lipase are just like AST and ALT in the liver…they are a function of how rapidly the cells are dying.
Often caught late if ever.
Deadliest cancer of all. Found esp in what region of the organ?
Pancreatic Adenocarcinoma - particularly the ductal adenocarcinoma type. Very aggressive even as a small cancer. Highly invasive and metastatic.
Risk Factors for Pancreatic Adenocarcinoma.
Tobacco, Age (mean age is 70 yo), Jewish and African Americans, DM, Chronic pancreatitis.
